Clinical and prognostic role of interim 18F-FDG PET/CT in elderly Hodgkin lymphoma: a dual-center experience

Albano, Domenico; Mazzoletti, Angelica; Zilioli, Vittorio Ruggero; Muzi, Cristina; Crucitti, Lara; Tucci, Alessandra; Pagani, Chiara; Re, Alessandro; Rossetti, Claudio; Giubbini, Raffaele; Bertagna, Francesco

doi:10.1080/10428194.2020.1797012

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Interim PET scanning performed after 2 cycles of conventional chemotherapy is standard of care in younger patients with cHL as mentioned previously, and this approach has been validated in older patients (48,49). These two studies confirm that interim PET positivity leads to poorer PFS and OS outcomes and reaffirm that interim PET should be performed in older patients with cHL as a means of prognostication and guidance of subsequent radiotherapy.…”

Section: Treatment Fit For Anthracyclinesupporting

confidence: 53%

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Barrett

Collins

2023

Front. Oncol.

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Since its initial description, classical Hodgkin lymphoma (cHL) portends a greatly improved prognosis and the goal of treatment in most patients is cure with minimisation of toxicity from treatment. Outcomes in older patients (>60 years old) lag behind those of their younger counterparts however, and cure remains achievable mostly for those who can tolerate full doses of conventional chemotherapy. This review addresses the difference in biology between younger and older patients with cHL and examines the impact of frailty and comorbidities on outcomes. The toxicities of conventional chemotherapy in anthracycline-fit and -unfit patients are examined, with a particular focus on pulmonary toxicity associated with bleomycin in older patients. New advances are discussed, including the possibility of using more targeted therapies such as the anti-CD30 antibody brentuximab vedotin (BV) and checkpoint inhibitors as a method of reducing dependency on conventional chemotherapy for those less well able to tolerate it. Treatment of older patients with cHL remains an area of unmet need in hematological research, and efforts to rectify this knowledge gap should continue.

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Section: Treatment Fit For Anthracyclinesupporting

confidence: 53%

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Barrett

Collins

2023

Front. Oncol.

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“…Finally, even if beyond the scope of the study, we could confirm in a wide population the impact of some ‘lymphoma‐related’ cHL prognostic factors even in the setting of the elderly population, such as advanced stage at diagnosis, the presence of B symptoms and the importance of obtaining an early complete response (DS 1 to 3) for patients undergoing ABVD/ABVD‐like treatments as recently demonstrated. 39 …”

Section: Discussionmentioning

confidence: 99%

Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience

Zilioli

Albano

Arcari

et al. 2021

J cachexia sarcopenia muscle

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Background Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness‐based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment‐related toxicities and worse survival in various solid tumours, but its impact in ecHL is unknown. The aim of this retrospective multicentre study was to investigate the prognostic role of sarcopenia in ecHL. Methods We included newly diagnosed >64 years old cHL patients who performed a baseline comprehensive geriatric assessment and high‐dose computed tomography (CT) or 18fluorine‐fluorodeoxyglucose positron emission tomography/CT before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) by the analysis of high‐dose CT or low‐dose positron emission tomography/CT images at the L3 level. The specific cut‐offs for the SMI were determined by receiver operator curve analysis and compared with those proposed in literature and studied in diffuse large B‐cell lymphoma. Survival functions [progression‐free survival [PFS] and overall survival (OS)] were calculated for the whole population and for different subgroups defined as per different sarcopenia cut‐off levels. Results We included 154 patients (median age 71 years old, 76 female). The median L3‐SMI was 42 cm2/m2. The specific cut‐off derived in our male population was 45 cm2/m2; using this cut‐off, 27 male patients (35%) were defined as sarcopenic. After a median follow‐up of 5.9 years, the overall 5‐year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic male patients compared with non‐sarcopenic (PFS 31% vs. 61%, P = 0.008; OS 51% vs. 74%, P = 0.042). Applying diffuse large B‐cell lymphoma‐derived sarcopenic thresholds, there were no significant differences between sarcopenic and non‐sarcopenic patients for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male patients using Namakura cut‐off. The comprehensive geriatric assessment‐determined frail functional status was an independent adverse prognostic factor for both female and male patients. Conclusions Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male patients with unfavourable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of patients with worse outcome.

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“…The prognosis of elderly HL patients is much worse than that of younger HL patients, due to the difficulties to digest aggressive chemotherapy protocols and comorbidities [ 2 , 3 ]. 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) is a non-invasive tool already studied in elderly HL [ 4 , 5 ]. Particularly, Deauville scores measured at interim and end-of-treatment PET and several semiquantitative baseline PET/CT parameters, such as metabolic tumor value (MTV) and total lesion glycolysis (TLG), are significantly related to survival [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) is a non-invasive tool already studied in elderly HL [ 4 , 5 ]. Particularly, Deauville scores measured at interim and end-of-treatment PET and several semiquantitative baseline PET/CT parameters, such as metabolic tumor value (MTV) and total lesion glycolysis (TLG), are significantly related to survival [ 4 , 5 ]. Besides these variables, sarcopenia also seems to have a prognostic impact for lymphoma [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Body Composition Changes Detected by [18F]FDG PET/CT during and after Chemotherapy and Their Prognostic Role in Elderly Hodgkin Lymphoma

Albano

Dondi

Treglia

et al. 2022

Cancers

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The aim of this retrospective study was to investigate the longitudinal body changes in terms of muscle and adipose areas and their prognostic role in elderly (>65 years) patients affected by Hodgkin lymphoma (HL). Skeletal muscle area (SMA), skeletal muscle index (SMI), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), and total dispose tissue (TAT) were measured using the computed tomography (CT) of fluorine-18-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT) in 88 patients who undertook baseline, interim (after two cycles of chemotherapy), and end-of-treatment (after 6 cycles of chemotherapy) PET/CT scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured at pre-treatment PET/CT. Metabolic response applying Deauville score was evaluated at interim and end-of-treatment PET/CT. Survival curves, such as progression free survival (PFS) and overall survival (OS), were calculated for the whole population. Fifty-eight (66%) patients had sarcopenia at baseline and sarcopenia rate increased at interim scan with 68 (77%) cases and at end-of-treatment scan with 73 (83%) cases. Muscular areas (SMA and SMI) declined significantly during the treatment (p < 0.001), decreasing from baseline by 5% and 7% at interim and end-of-treatment evaluation, respectively. Instead, VAT, SAT, IMAT, and TAT increased significantly over this time (p < 0.001). Sarcopenia was significantly related with comprehensive geriatric assessment. PET/CT response at interim and end-of-treatment, MTV, TLG, and baseline sarcopenia were independent prognostic factors for PFS. Instead, metabolic response at interim and end-of-treatment PET, baseline sarcopenia, ΔSMI at interim, and ΔSMI at end-of-treatment for OS were independent prognostic factors.

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Clinical and prognostic role of interim 18F-FDG PET/CT in elderly Hodgkin lymphoma: a dual-center experience

Cited by 6 publications

References 23 publications

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience

Longitudinal Body Composition Changes Detected by [18F]FDG PET/CT during and after Chemotherapy and Their Prognostic Role in Elderly Hodgkin Lymphoma

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